Renal and Hepatic Adjustments

Question 1

Define Glomerular Filtration Rate

Answer 1

Amount of plasma that is filtered by all nephrons per unit of time

Question 2

GFR does not include

Answer 2

Tubular secretion or reabsorption
Non-renal breakdown
Protein binding and freely filterable
Interfering compounds

Question 3

Exogenous markers of GFR

Answer 3

Inulin
Sinistrin
Iothalamate
Iohexol
Radioisotopes

Question 4

Endogenous markers of GFR

Answer 4

Creatinine

Cystatin C

Question 5

Creatinine come from

Answer 5

breakdown of creatine metabolism from muscles

Question 6

Creatinine is directly dependent on:

Answer 6

muscle mass, age, gender, race, and lean body mass

Question 7

Decreased renal function =

Answer 7

increased serum creatinine

Question 8

Cirrhotics/End Stage Liver DIsease

Answer 8

Lower-than-expected Scr concentrations values secondary to: reduced muscle mass, protein poor diet, diminished hepatic synthesis of creatine and/or fluid overload

Question 9

Pregnacy

Answer 9

Measure 24 hour urine creatinine excretion to determine clearance
Formulas are inaccurate

Question 10

Critically ill

Answer 10

Creatinine production may be increased or decreased

Formulas and 24 hr creatinine collection are both inaccurate

Question 11

Morbidly obese (BMI greater than 40)

Answer 11

May need to calculate lean body weight but not sure which weight to use in formulas

Question 12

Geriatrics

Answer 12

Do not round!!!

Question 13

Peds specific GFR estimation formulas

Answer 13

Schwartz and CKiD Scwartz

Question 14

CrCl =

Answer 14

(140-age) * IBW * 0.85 for females
__________________________
72* SCr

Question 15

MDRD stands for

Answer 15

Modified Diet in Renal Disease

Question 16

MDRD indication

Answer 16

Recommended for use in patients with a history of CKD risk factors and a GFR less than 60

Question 17

CKD-EPI

Answer 17

More accurate than MDRD when evaluating GFR greater than 60 and less bias in all GFR ranges

Question 18

Schwartz equations do not provide accurate GFR estimations for

Answer 18

pts with normal renal function greater than 75 or advanced renal failure less than 15

Question 19

Drug elimination by hemodialysis is highly dependent on:

Answer 19

drug size, hydrophilicity, ionization, protein binding
Increased Vd, decreased plasma protein, recovering renal function
Continuous HD vs intermittent

Question 20

Liver enzymes tell you what?

Answer 20

Help identify hepatic dysfunction but NOT quantify function

Question 21

Child Pugh Score takes into consideration?

Answer 21

Bilirubin
Serum albumin
INR
Ascites
Hepatic encephalopathy

Question 22

MELD stands for

Answer 22

Model for End Stage Liver Disease

Question 23

MELD uses:

Answer 23

serum bilirubin
serum creatinine
INR

Question 24

MELD is used to:

Answer 24

prioritize transplant patients >12 years old

Question 25

Hepatic dose adjustments

Answer 25

Low hepatic excretion ratio drugs - maintenance dose needs to be reduced High hepatic excretion ration drugs- loading and maintenance doses need to be reduced Drugs that undergo P450 metabolism

Question 26

Low hepatic excretion ratio drugs are:

Answer 26

Diazepam

Question 27

High hepatic excretion ratio drugs are:

Answer 27

Lidocaine